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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date r/ I Z_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATES /�/Z <br /> VALID i 2 0 �'/S"/Z DRIVEWAYS: <br /> Pacific Gas and Electric Co. j STREET ��F� Ams. <br /> P.O. Box 930 AREA QUAD <br /> TYPE �) GL,t�i`CES <br /> Stockton, CA 95201 FORMSw�; ,�z9 <br /> NOTES <br /> LZ '700 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. ; Shall be as per <br /> PM 3 D C1 (`157 s- current M.U.T.C.D. <br /> Notif. i y5 3 3 g a California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the F, side of 5+a (C'E s A O 6 approximately 4fRS? feedmile Py <br /> of E- t=v� wt Q t{- S f . 5 AOC ell A) by performing the following work(description of work): <br /> F x CAVA -E (,z) 5 k S 6E11- 141.ps (3) 7-',t2- --D4 Ndes bole 5'70 - of <br /> ',_ 1� C P L ✓(/i✓a i e A� Jro, Af r uor �a / /i< 5il o <br /> e4 N�1�• /411 L Gt,D/Z/� -1-b � 1, a✓,c /Iv i R , <br /> Work will commence on or about_ s �' /z for approximately 9'0 days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordanc with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> // 1'/— /O — /..), <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT APPUCATIOMDOC (01108) <br />